What the Trade Union movement can learn from the junior doctors’ dispute. (Part 1)

Sat 27th Aug 2016

All industrial disputes should be assessed to see what we can learn for the future, and the junior doctors’ dispute is no different. In the first of this two-part article, we will consider what elements of the campaign we would wish to emulate in other unions and other disputes. We will then look at the factors that led to the successful outcomes. In the second part we will look at what didn’t work so well, so we can avoid these features in future. We will also explore what has changed over the past year, and look towards what we might do in the future.

I would argue that the main features of the campaign which we should replicate are:

· We gained and retained massive public support.

· We generated a large amount of media attention

· We had a very large turn-out for our original strike ballot, with 76% of those eligible voting in the ballot. We also had a very clear mandate for action, 98.4% voted for strike action and 99% for action short of a strike.

· We had a good turn out on the pickets. For example, on the last day of action outside the Bristol Royal Infirmary we had close to 200 people on the picket line throughout the day.

These were clearly things we would want to strive for and so it is important to consider how these outcomes might have come about.

Essentially there was a tremendous feeling of involvement by junior doctors, and significant contributions by grassroots activism. We also had a fairly easy message to sell. I would also argue there are some features specific to doctors as a group that strengthened the campaign.

A significant factor in this being a successful campaign was the massive feeling of involvement by grassroots junior doctors. A key factor for achieving this was the Facebook group, “The Junior Doctors Contract Forum”.

This Facebook group has a membership of over 60,000 people, including the vast majority of junior doctors in the country. Vitally, the group also includes the members of the Junior Doctors’ Committee (JDC), who were negotiating with the department of health on our behalf. It therefore provides an easy way for the leadership to rapidly sound out the views of the wider membership. The leadership reports that this was empowering because it meant they could canvas the membership whenever they moved forwards with a tactic or approach. This also worked the other way; grassroot doctors (such as myself) were given an immense sense that they were part of the debate and the decision making process, as we could talk directly to our leadership 24/7. The leadership also pointed out that the group enabled them to identify grassroots members with potential as spokespeople in interviews, authors of articles or local campaigners.

As I hope I have illustrated, there were many positive outcomes from this group. However, it would be remiss not to mention the challenges that it generated. Firstly, the group is almost entirely unmoderated and independent of the BMA hierarchy.

This means that the union was running a dispute in the presence of a campaigning tool they have no control over. This is obviously an unusual way of organising. However, the lack of formal BMA input can be a silver lining. When, as occasionally happens within a group of 60,000 people, somebody says something off the wall or something that is clearly not BMA policy, the union can justifiably hold up their hands and plead innocence on the basis that “We don’t control what is said on the forum”.

There is also the fact that the forum has been infiltrated by the right wing press. Therefore, all our discussions are being monitored; several of the “scandals” that the right wing press have broken over the past year have very clearly been lifted from discussions on the forum the previous day. Therefore, we have had to assume that what one says today may well end up in the Daily Mail tomorrow”.

Another challenge that has developed due to this ease of access to junior doctors nationally is the risk of people with ulterior motives. Although obviously all junior doctors want a rapid and satisfactory conclusion to the dispute, there is strong suspicion that there are some people in the group who are focusing more on self advancement, and so attempt to build their own powerbases by attacking the leadership. Over the past year we have stayed remarkably united as a profession, however there is always the risk of factions and splitting, and this is partially exacerbated by the Facebook group.

Finally, the group has allowed us to become used to a 24/7 news cycle; whenever anything happens with the struggle the leadership can communicate to us what is happening and why. This is clearly a strength, but it does pose some challenges when it suddenly stops.

A few weeks ago we narrowly voted to reject the contract offer, and on a lower turn out than we have been used to. As a result of this there was a very amicable change of leadership of the JDC. The new leadership, quite rightly in my opinion, are taking their time to survey and discuss issues with the wider membership to ensure that whatever action they do recommend, has the clear and explicit support of the membership and that further negotiations with the Department of Health are focused on the clauses that the membership finds most objectionable. However, as this has suddenly ended the constant steam of news on the Facebook group, it has caused some people to panic and level accusations that the union is going to betray the membership and that the new leadership is not up to the job of fighting for us.

Although I feel that the Facebook group has been key, this has not been a social media revolution. Face to face meetings have also played a vital role in our success. In the run up to the ballot on the new contract, the leadership of the JDC embarked on a massive 120 date roadshow around the country, speaking to junior doctors about the contract, hearing what they had to say and what their priorities and concerns were. This again made grassroots members feel involved in the decision making process.

Unsurprisingly, this dispute has involved a very large amount of grassroots activism, and this is something that should be replicated in other struggles and unions. Partially this activism was a function of the oft mentioned Facebook group. It was very easy to use the group to pick up and adopt good practice from others. An example of this occurred early on in the dispute where some junior doctors in Bath decided to take a stall out into town so that the general public could meet them and ask questions as a way to combat the myths and misinformation being spread about the dispute. This appeared to be a success and, after being shared on the group, was rapidly adopted by other doctors around the country.

Another way that I personally feel the Facebook group has promoted grassroots activism is that there is no hierarchy in the group. Therefore grassroots doctors who, in another context might feel intimidated and think that important actions and decisions should be left to the leadership, are much more likely to speak up, suggest and carry out actions themselves. Good examples of this are the establishment of the National Health Singers, recruiting celebrities to the cause, national leafletting campaigns, ongoing picketing of the Department of Health and legal challenges to various parts of the contract. All of these tactics were generated and carried out by grassroots members.

A further strength of this dispute is that, in contrast to most campaigns, we have a very large variety of public speakers who can be put up for interviews and rallies. This has both shown the breadth of the campaign, but also made it much harder for our opponents to target spokespeople personally. For example, although there was an attempt to attack Johann Malawana (the JDC Chair through most of the dispute) over his wedding photography business, it is almost impossible to individually smear all of the spokespeople.

It helped that we had a fairly easy message to sell to the public in that we kept our message very focused on patient safety and the unfairness of the contract. We refused to talk much about money, which is what Jeremy Hunt and the government wanted to talk about.

It also helped that, although our dispute was about the contract, we had much common ground with other campaigners. It was very easy for those with wider agendas, such as anti-privatisation, to link up with us. Finally, Hunt’s message that this contract is the only way forward was seriously undermined by the fact that none of the devolved governments are planning to introduce it.

There are some factors that contributed to the success of this dispute related to the nature of doctors as a group. Firstly, doctors have a very high rate of union membership. This is because almost all join the BMA while we are students and continue our membership because it gives us access to the British Medical Journal. There has been an increase in membership over the course of the past year, but we were already starting from a very high level. It may be a controversial position, but I feel that an important contributing factor to the success of this campaign is that most, but not all, doctors are from a middle class background, have a fairy privileged upbringing and generally are treated well by life. It was therefore a major culture shock when the Secretary of State turned around and said “No, you can’t have what you want. You have to do what I want”. This caused indignation and a desire to fight back against this abnormal phenomenon. With other groups of workers who have not lived such a charmed existence, there may well have been more willingness to accept the unfairness of the contract on the basis that it is not unusual for them to be so explicitly exploited.

I have mentioned many contributory factors to the success of this campaign. In essence, these are all elements of effective communication. Firstly Facebook, alongside other means of mass communication, has strengthened relationships between the leadership and grassroots. Secondly, the leadership has been touring the country to have face-to-face discussions and debates with the membership. This should be a focus in other unions and other disputes.

In the next article we will examine how things have changed over the past year, and discuss what junior doctors and the wider movement should focus on going forwards.